LOS ANGELES -- Transplanting a lung from a heavy smoker doesn't appear to hurt the recipient's outcomes over the mid-term, a national registry suggested.

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This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Lung transplantation from donors with a history of heavy smoking doesn't appear to hurt recipient outcomes over the mid-term.

Point out that the results support relaxing the organ donor criteria to alleviate the shortage of donor lungs, which could decrease waiting list mortality.

LOS ANGELES -- Transplanting a lung from a donor with a history heavy smoking doesn't appear to hurt the recipient's outcomes over the mid-term, a national registry suggested.

The most important outcome -- overall survival -- wasn't worse for individuals who received lungs from heavy smokers than from other donors on multivariable analysis (P=0.685), Sharven Taghavi, MD, of Temple University Hospital in Philadelphia, and colleagues found.

Peak lung function and malignancy risk afterward were also similar between types of donor lungs, the group reported here at the Society of Thoracic Surgery (STS) meeting.

"Historically we have considered donors who have over 20 pack-years of smoking history to be less than ideal donors," Taghavi explained in an interview with MedPage Today.

These results support relaxing the organ donor criteria to alleviate the shortage of donor lungs, which could decrease waiting list mortality, he suggested.

"It's not an ideal choice, perhaps, to offer the smoker's lung, but it's better than the next best option," STS secretary Keith Naunheim, MD, of St. Louis University Health Sciences Center, said at a press conference he moderated.

Without a lung transplant, end-stage respiratory disease has an expected survival of 1 or 2 years.

Only about half of those on the waiting list in a given year get a lung transplant, according to the National Heart, Lung and Blood Institute.

Not all smokers' lungs would be suitable, the group cautioned, noting that their results reflected careful selection by the transplanting physicians.

Rather, the similarity in outcomes in such cases "confirms the belief of many lung transplant surgeons that heavy smoking history alone should not be used to decline otherwise suitable organs for transplantation," Thomas D'Amico, MD, chief of general thoracic surgery at Duke University Medical Center, commented in an email.

"It is, however, incumbent upon transplant surgeons to thoroughly evaluate the lungs in donors with heavy smoking history for occult carcinomas prior to transplantation, as for other reasons that would preclude safe transplantation," he added.

The study didn't have specific data on lung cancers among recipients of heavy smoker lungs, but there was no significant difference in deaths from malignancy overall compared with other lung transplant recipients in the study (4% versus 6%, P=0.100).

Further study is needed, but it would be prudent to carefully examine donor lungs from heavy smokers using chest x-ray, CT scan, and fiber-optic bronchoscopy as well as visual inspection at procurement, Taghavi suggested.

His group's study included all 5,900 double-lung transplant recipients in the United Network for Organ Sharing database from 2005 through 2011.

Among them, 13% (766) received those organs from heavy smokers, who had smoked at least a pack a day for more than 20 years. Taghavi noted that many of these recipients were smokers themselves.

The two groups were similar in recipient age, gender balance, and lung allocation score (45.8 versus 44.9, P=0.184).

Drop in FEV1 after transplantation came out similar (P=0.123), as did peak FEV1 with the new lungs (80% heavy smoker versus 79% other, P=0.513).

Median survival was 5.6 years among recipients of heavy smokers' lungs versus 5.3 years with other lungs, which remained similar between groups after adjustment for other factors, with a hazard ratio of 1.003 (95% CI 0.867 to 1.161).

The one difference was a 1-day longer length of stay among the heavy smoker lung recipients (P<0.001), which Taghavi called of questionable clinical significance.

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